Single monosomy as a relatively better survival factor in acute myeloid leukemia patients with monosomal karyotype.

Jaeyeon Jang ,J Park,S M Lee,S K Park,W S Lee,J H Lee,S Park,Jang Ho Yoon ,Js Ahn ,Chul Won Jung ,Yoo Hong Min ,Lee Kh ,In‐Wook Kim ,Lee Jh ,Min Ws ,Shin Hj ,Jun‐Ho Jang ,Hyung Jun Kim ,Joo Seop Chung ,Hong Ds ,June Won Cheong

doi:10.1038/bcj.2015.84

Abstract

Monosomal karyotype (MK) defined by either ⩾2 autosomal monosomies or single monosomy with at least one additional structural chromosomal abnormality is associated with a dismal prognosis in patients with acute myeloid leukemia (AML). It was detected in 174 of 3041 AML patients in South Korean Registry. A total of 119 patients who had received induction therapy were finally analyzed to evaluate the predictive factors for a positive prognosis. On multivariate analysis, single monosomy, the absence of abn(17p), ⩾10% of cells with normal metaphase and the achievement of a complete remission (CR) after induction therapy were significant factors for more favorable outcomes. Especially, single monosomy remained as a significantly independent prognostic factor for superior survival in both patients who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in CR and who did not. Allo-HSCT in CR improved overall survival significantly only in patients with a single monosomy. Our results suggest that MK-AML may be biologically different according to the karyotypic subtype and that allo-HSCT in CR should be strongly recommended to patients with a single monosomy. For other patients, more prudent treatment strategies should be examined. Furthermore, the biological mechanism by which a single monosomy influences survival should be investigated.

Highlights

Several different cytogenetic classifications exist for acute myeloid leukemia (AML), it has been generally agreed that specific cytogenetic abnormalities result in unfavorable prognoses
We retrospectively analyzed Monosomal karyotype (MK)-AML patients using a nationwide database from South Korean AML Registry to evaluate the predictive factors for better prognoses and to feature out clinical heterogeneity of patients according to the type of MK
MK-AML accounted for ~ 5.7% of Korean AML population, and was associated with lower complete remission (CR) rate after induction therapy and extremely poor outcomes, which is consistent with previous studies.[5,7,16]

Summary

Introduction

Several different cytogenetic classifications exist for acute myeloid leukemia (AML), it has been generally agreed that specific cytogenetic abnormalities result in unfavorable prognoses. CR rate decreased with age as a numerical variable (1-year old, P = 0.008), and the presence of ⩾ 10% of cells with normal metaphase was another good prognostic factor for CR after induction therapy (P = 0.002) in univariate analysis.

Results

Conclusion